Longitudinal Evaluation of Neuro-PASC Symptoms

ABSTRACT

Objective: A longitudinal study (NeuCovid) was created at UC San Diego to compare the long-term neurological outcomes of SARS-CoV-2 infection in two cohorts, patients with and without prior neurologic disease. Background: While cross-sectional analyses have demonstrated the prevalence of neurological symptoms in the Post-Acute Sequelae of SARS-CoV-2 infection (PASC), the evolution of these symptoms over time has not yet been well-described. Design/Methods: Participants with neurological symptoms post-acute infection with SARS-CoV-2 were recruited. Team members conducted assessments including a detailed SARS-CoV-2 infection history, neurologic review of systems (scored on 10-point severity scale), neurologic exam, MoCA exam, and self-reported neuropsychiatric questionnaires, at baseline (conducted after acute infection resolved) and at 3-,6-, and 12-month follow-ups. As appropriate, participants were referred for imaging and neuropsychological testing. We report 6-month data, but 12-month data will be available in 2022. Results: 61 participants (69% female, mean age 50.2 years) were enrolled, 18 with prior known neurological disease. Acute COVID-19 disease severity was largely described as mild (44.4%) or moderate (48.1%). To date, 27 participants (74% female, mean age 52.6 years) completed baseline and 6-month follow-up visits. At baseline, the most common symptoms included fatigue (85.2%), headaches (74.1%), memory impairment (59.3%), insomnia (55.6%), and decreased concentration (48.1%). Complete symptom resolution was reported in 33.3% at 6-month follow-up. In the remaining participants at 6 months, persistent memory impairment (68.8%), decreased concentration (61.5%), fatigue (52.2%), insomnia (46.7%), and headache (45.0%) were reported. Average severity score decreased for fatigue (69.4%), headache (64.3%), insomnia (51.3%), decreased concentration (47.6%), and memory impairment (38.6%). Average MoCA scores improved from baseline (n=19, 26.4 to 28.0). Conclusions: Early in neuro-PASC, fatigue and headache were the most common reported symptoms. At 6-month follow-up, memory impairment and decreased concentration were most prominent. Only a third of participants had complete resolution of neuro-PASC symptoms at 6 months.